STATE OF _______________________ COUNTY OF _____________________ _______________________________________________________, the affiant(s) herein, being sworn, state(s): 1. That affiant(s) and ___________________________________________________ is/are the successor(s) of ____________________________, deceased. 2. That the fair market value of property owned by the decedent and subject to disposition by will or intestate succession at the time of the decedent’s death, wherever that property is located, less liens and encumbrances, does not exceed fifty thousand dollars. * 3. That at least ten days have elapsed since the death of the decedent. 4. That no Application or Petition for the appointment of a personal representative is pending or has been granted in any jurisdiction. 5. That the affiant(s) and ___________________________________, as successor(s) of the decedent, is/are entitled to the payment of any sums of money due and owing to the decedent, and to the delivery of all tangible personal property belonging to the decedent and in the possession of another, and to the delivery of all instruments evidencing a debt, obligation, stock or chose in action belonging to the decedent, in the following respective proportions: NAME OF SUCCESSOR PROPORTION _________________________________________ Signature of Affiant ______________________________________ Signature of Affiant ________________________________________ Signature of Affiant ______________________________________ Signature of Affiant Subscribed and affirmed, or sworn to before me in the County of ______________________, State of ________________, this ___________ day of _______________, 20 _______. My commission expires: ________________________ ______________________________________ Notary Public NOTE: This Affidavit is pursuant to §15-12-1201 of the Colorado Probate Code as amended effective July 1, 1981. It can be used either by one affiant on behalf of all successors or by all successors as affiants. It cannot be used to transfer the title to any real property owned by the decedent. * Twenty-seven thousand dollars if decedent died prior to July 1, 2002. CPC 40 R7/02 AFFIDAVIT FOR COLLECTION OF PERSONAL PROPERTY PURSUANT TO SMALL ESTATE PROCEEDING This form conforms in substance to CPC 40. American LegalNet, Inc. www.USCourtForms.com